The release of the 2014 Edition Standards and Certification Criteria, published in tandem with the stage 2 meaningful use rules, brought with it a slew of new federal requirements for technology vendors hoping to craft certified electronic health record products. Few of these regulations are expected to have as much of an affect as the collection of care coordination standards, which will force vendors to produce systems capable of exchanging data, reconciling old patient information with new and collaborating with other systems.
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In addition to affecting the health care industry as a whole, some of the requirements could be challenging for vendors to comply with, say IT professionals. The ability of technology providers to match their offerings to the new regulations could determine how successful providers are in implementing coordinated care models, such accountable care organizations (ACO).
Enterprises are going to have to decide: 'are we going to push everyone in the community in a certain direction, or are we going to provide more interoperable solutions?'
Eric Leader, director of product management and business intelligence, Harris Healthcare
The care coordination section of the certification criteria states meaningful use-certified EHRs must be able to create, send, receive and display standardized transition of care documents. Additionally, systems must be able to support electronic prescribing, reconcile previous patient information into a current record, incorporate laboratory test results and create care summaries for patients.
While certified EHR systems have been capable of performing some of these tasks for years, other requirements will force vendors to add new functionality.
Interoperability requirements increase
One of the largest leaps forward in the updated certification standards may be the requirement that certified EHR systems be capable of working with standardized documents. Amit Trivedi, healthcare program manager at ICSA Labs, which is recognized by the Office of the National Coordinator for Health IT (ONC) as an authorized testing and certification body, said interoperability is not something EHR vendors have traditionally worried about. In fact, there has been little reason for vendors to consider it.
Trivedi said prior to the meaningful use program, the health IT market wasn't historically set up to reward vendors that used widely accepted standards. Doing so would have made it easier for health care providers to pick and choose a variety of vendors for different products, such as laboratory information systems, billing and scheduling software and EHRs.
The first round of certification standards did require some level of interoperability, but Trivedi said vendors could get by with simply demonstrating that their systems could theoretically transfer data to other systems. There was no requirement for systems to support specific interoperable clinical functions.
The new specifications requiring the support of standardized clinical documents, such as referral summaries and summary of care documents, could change this. "That's what's going to make a big difference. That's going to facilitate care coordination," Trivedi said.
Eric Leader, director of product management and business intelligence at Harris Healthcare, agreed that the tightened interoperability standards represent one of the biggest technological advancements in the updated certification standards. They will also be some of the toughest for vendors to deal with.
As EHR vendors are increasingly forced to standardize their products, Leader sees a number of smaller companies being squeezed out by the tight competition. Vendors that do not find ways to make their products interoperable while at the same time innovating will have a hard time attracting customers in a crowded market.
"It's going to drive some interesting decision points for enterprises who are going to have to decide, 'are we going to push everyone in the community in a certain direction, or are we going to provide more interoperable solutions?'" Leader said. He added he expects most vendors to look for ways to support interoperability while continuing to differentiate themselves.
Updated technical language could pose problems
The updated certification standards specify all certified EHR systems must use consolidated clinical document architecture (CCDA) to transfer summary of care documents. This is a change from the previous standards, which specified the use of continuity of care documents (CCD) or continuity of care records (CCR). While all three formats use XML standards to encode data, the change could lead to difficulties for some vendors.
Bill Spooner, CIO of Sharp Healthcare of San Diego, said some vendors initially struggled with the CCD/CCR requirements of the older certification standards. While specific vendors he has spoken to said they don't expect to have problems, the change of document transfer standards could represent a challenge for other companies, he said.
Trivedi described the CCDA requirement as one of the more "aggressive" provisions that the ONC included in the updated certification rules. He said the new standard is capable of packing a lot of important clinical information into a standardized format, which has its advantages. But the standard is less mature than the CCD/CCR format used in the 2009 certification standards. Still, he said CCDA is similar enough to the earlier standards, so the majority of vendors should be able to implement it eventually.
This was first published in September 2012